Independent Study Final Paper: Use of Sand Trays in the Retreat Experience for Oncology Patients

Kristy Brosz

ID# 229954

SOWK 699.25 (Sec 08)—Winter 2012

Dr. Steven Simpson

University of Calgary

Table of Contents Use of Sand Trays in the Retreat Experience for Oncology Patients.............................................................3

1: Introduction ...........................................................................................................................................3

1.1: Organization ...................................................................................................................................3

2: Methodology and Summary of Sources ................................................................................................3

2.1: Methodology ..................................................................................................................................4

2.2: Summary of Sources .......................................................................................................................5

3: Definition of Key Constructs ..................................................................................................................5

4: Healing Philosophy of Sand Tray Therapy .............................................................................................6

4.1: Comparisons of Sand Tray Approaches ..........................................................................................6

4.2: Philosophy of Sand Tray Therapy: Use of the Unconscious ...........................................................7

4.3: Unique Healing Potential of Group Sandtrays ............................................................................ 11

5: Case Examples of Sandtray in Oncology and Chronic Illness. ............................................................ 11

5.1: Use with Chronic Illness .............................................................................................................. 12

5.2: Use with Breast and Ovarian Cancer ........................................................................................... 13

5.3: Sandtray Execution in Retreat Experience for Oncology Patients .............................................. 14

6: Connection of Sand Tray Experience to Retreat Program, General Psychosocial Oncology, and Clinical Social Work Practice ............................................................................................................ 25

7: Concluding Remarks ........................................................................................................................... 27

References .............................................................................................................................................. 29

Use of Sand Trays in the Retreat Experience for Oncology Patients

1: Introduction Sandtrays as a therapeutic modality involves the creation of scenes in the sand using miniatures

or icons. This modality allows “the client to create a world that provides concrete testimony to

inner thoughts and feelings. This world can be viewed, touched, experienced, changed,

discussed, and photographed” (Labovitz and Goodwin, 2000, p. 17).

Sandtray therapy has been utilized in a variety of therapeutic contexts for children, adults, and

groups to address profound experiences that may otherwise be difficult to address through

traditional verbalization in the therapeutic context. One such profound experience can be the

cancer journey that has the potential to affect the client’s view of self and “involve intense

feelings of fear, grief, rage, or despair in which the use of verbal methods alone may limit the

extent to which representations of illness can be explored in therapy” (Lagurina, Sperlinger &

Esterhuyzen, 2011, p. 1-2). Therefore, this paper will explore the use of sandtray in the retreat

experience for oncology patients.

1.1: Organization This paper will begin with Section 2 providing a summary of sources utilized for this review;

Section 3 provides definitions of key constructs. Section 4 will then explore the healing

philosophies behind the therapeutic modality of sandtray therapy. The middle of this paper

(Section 5) will describe three case examples for the use of sandtray therapy that includes use in

chronic illness, oncology, and the residential retreat experience for oncology patients. Section

6 provides a link between sandtrays and general themes within the retreat experience,

psychosocial oncology, and clinical social work practice. Finally, Section 7 will provide concluding

remarks.

2: Methodology and Summary of Sources

This section will provide a summary of the methodology utilized for this review (Section 2.1) and

a summary of the sources reviewed (Section 2.2).

2.1: Methodology In November and December 2011, searches for peer-reviewed journal articles and dissertations

were conducted using the University of Calgary online databases in the areas of social work,

psychology, medicine, and nursing. In addition to these databases, searches from the Google

Scholar database with the same key word searches were conducted to obtain additional

background information . Key word search included the following phrases, either singularly or in

combination: sandtray, sandplay, therapeutic relationship, group sandtray, chronic illness,

oncology, psychosocial oncology. A summary of these searches are documented in Table 2.1

Table 2.1: Summary of literature searches conducted for review in November and December 2011.

Data Bases Searched Key Word Searches

(Utilized Singularly or in

Combination)

Number of Sources

Selected

SociINDEX with full abstracts

Sandtray; sandplay; therapeutic

relationship; group sandtray;

chronic illness; oncology;

psychosocial oncology

0

Social Work Abstracts 8

Social Services Abstracts 3

Psychology and Behavioural Sciences Collection 9

CINAHL Plus with full text

7

Academic Search Complete 17

Academic ONE File 3

PsycINFO 23

Academic Search Complete (EBSCO) 8

Expanded Academic ASAP 0

Journal Citation Reports (JCR) 7

Google Scholar 23

TOTAL 108

Initial inclusion criteria included articles written in English, current within the last ten years, and

contained the key word searches within the abstract. Given the limited results obtained from

this search, selection of sources were then expanded to include sources current within the last

twenty years, key word searches anywhere in the article, and inclusion of meta-analyses from

international sources. Finally, in order to provide a complete picture on both the historical

context and emerging areas related to this topic, sources cited within articles previously

selected were reviewed as well as select grey literatures sources covering the historical context

for the use of sandtrays.

2.2: Summary of Sources 63 total sources were reviewed, with approximately 65% US sources, 20% Canadian sources and

15% international sources. Half were current within the last 5 years, approximately one quarter

published within the last 10 years, and the rest of the source were current within the last 20

years. Sources included: 16 research-based articles; 20 theory or review based articles; 7 books;

5 websites; and 15 grey literature sources such as reports and prepared manuals.

In general, the literature on this area contained evidence for the use of sandtrays for a variety of

clients including children, adults and groups in an assortment of settings. However, given the

larger range of uses for sandtrays most of the evidence was focused in the form of books and

manuals for the execution and interpretation of sandtrays. Nine research articles consisted of

single case studies that that then extrapolated large generalizations. Very little evidence (n=3)

was focused on the effectiveness of sandtray therapy with illness, specifically in oncology. In

addition, the majority of the evidence focused on the use of sandtrays as a part of therapy, not

as a therapeutic modality within itself. No literature was available on the use of sandtrays within

a retreat setting similar to Tapestry (see Section 5.3).

3: Definition of Key Constructs

Given the wide variety of working definitions within the literature, this section will provide

definition for key constructs to frame the exploration of the use of sandtrays within a residential

retreat experience for oncology patients. These include the following six constructs:

Client: The sandplayer engaged in the creation of the sandtray scene (Sandtray

Network, 2011; Canadian Assocation of Sandplay Therapists, 2011; Castellana & Krish,

2006).

Therapist: Individual who is trained in the history and therapeutic process to facilitate

sandtray therapy (Sandtray Network, 2011; Meyer, 2004; Turner, 1994).

Sandplay: “A psychotherapeutic technique that enables clients to arrange minatures

figures in a sandbox or sandtray to create a sandworld corresponding to various

dimensions of his/her social reality” (Zhou, 1999, p.69).

Sand Tray Therapy: An expressive and projective mode of therapy involving a healing

process through the use of specific sand tray materials as a nonverbal medium of

communication, led by the client(s) and facilitated by the therapist (Homeyer &

Sweeney, 2011; Kwasniewki,2005; Canadian Association of Sandplay Therapists, 2011;

Sandtray Therapy Institute, 2011; Castellana & Krish, 2006).

Miniatures/Icons: The physical objects selected and placed within the sand that are

symbols and/or metaphors for the client’s nonverbal communication (Homeyer &

Sweeney, 2011).

Residential Retreat Experience for Oncology Patients: A unique experience where

patients are given respite from day-to-day responsibilities to focus on the spiritual,

existential, and holistic aspects of the cancer experience that are typically not explored

in more traditional group therapies (Dr. J. Steven Simpson, Personal Communication,

2011).

4: Healing Philosophy of Sand Tray Therapy To discuss the healing philosophy of sand tray therapy, this section will explore: the historical

context of sandtrays and compare four approaches to this practice (Section 4.1); explore the use

of unconscious within sandplay (Section 4.2); and the unique healing power of group sandtrays

(Section 4.3).

4.1: Comparisons of Sand Tray Approaches Sandplay therapy was first explored through from the creation of Lownefled’s World Apparatus

founded on the notion that play brings about the potential for symbolism and insight into the

unconscious. From this work, there have been many conceptualizations for the use of sandplay

therapy. Table 4.1 provides an overview of four key representations of the use of sandtray

therapy based on how the following areas are conceptualized: goals of therapy; purpose of the

sandtray; use and interpretation of symbols; and interpretations of the sandtray.

Table 4.1: Comparison of Four Conceptualizations and Uses of Sandtray Therapy.

Area of

Comparison

Lowenfeld

(Lowenfeld, 2011)

Kalff

(Kalff, 2007)

Weinrib

(Weinrib, 1983)

De

Domenico

(De Domenico, 2005)

Goal of Therapy Central task is making contact with the whole patient’s mind, through direct and conscious knowledge and understanding of the laws of the mind.

The central task is the realization and interpretation of psychoanalytic theories.

Healing and the expansion of the consciousness.

To increase one’s ability to live a more actively conscious life and be connected to the multiplicity of experiences in daily life.

Purpose of the Sandtray

The client will be able to demonstrate his/her own mental state at any particular moment in time.

To create a three-dimensional unconscious aspect of the client’s psyche.

To execute a symbolic and creative act/symbolic ritual.

To assist the client in making the unconscious more conscious.

Use and Interpretation of Symbols

The meaning of symbols of focused on the meaning the client attributes to objects as the sandtray is created.

Symbols are to be interpreted by the therapist.

Symbols are evaluated by the therapist in light of Jungian interpretation of symbols.

The symbolic nature of items within the sandtray are determined by the client.

Interpretations of sandtray

It is essential that no interpretation be given by the therapist, rather that the client is able to describe their own interpretation. The value in the sandtray process is to allow the creator to experience it, rather than have the therapist confront the client about the world they have created.

The therapists interprets the sandtray and it is not necessary for the therapist’s insight to be communicated to the client.

The therapist evaluates based on Jungian symbols, but there is no interpretation during the session.

Interpretations by the therapist are not helpful to the client and hinder the creative and healing process of the sandtray.

As each of the conceptualizations within Table 4.1 have a range of evidence bases supporting

their conceptualization, this paper will explore the use of sandtrays through utilizing elements

from each of these conceptualizations.

4.2: Philosophy of Sand Tray Therapy: Use of the Unconscious Sandplay provides a connecting bridge from an individual’s intrapsychic reality to the reality of

the outer world. Through sandplay, the unconscious/non-verbal aspects of the individual are

able to be made conscious/verbal (DeDomenico, 1995; Broadway & McCoonad, 1997; Rae,

1998). The effect of sandplay tends to harmonize “the vital relationship between the psyche,

soma, and spirit….through tapping into the healing power of play, clients move from being

victims of experiences to being creators of experiences.” (DeDomenico, 1995, p. v).Therefore,

important elements within the philosophy of sandtray therapy involve the use of the

unconscious and specific rituals within the process.

The foundational basis for being able to use the healing inherent within the unconscious

involves the unique use of play. Homeyer & Sweeney propose that there are several unique

attributes about play that are important to consider within the sandplay process:

Play is voluntary by nature and in a world full of rules and requirements, play is

refreshing and contains potential for respite.

Play is free from evaluation and judgment with the freedom to make mistakes.

Play encourages fantasy and the use of the imagination, enabling control without

competition.

Play increases involvement and interest.

Play encourages the development of self.

(Homeyer & Sweeny, 2011, p. 2)

Taken together, these elements of play form a solid foundation for the use of the unconscious

within the sandtray process. This allows for an expanded focus beyond the cognitive issues that

verbal therapies tend to focus on.

Given this consideration to the heart, or unconsciousness, the sandtray process contains many

interconnected strengths inherent within this process as outlined by Armstrong to include the

following:

1. Indirectness of the Sandtray experience: Clients are able to express a wide range of

their lived experiences involving multiple systems within their worlds rather than

focusing on answering a specific question in therapy.

2. Kinesthetic Quality of Sandtray: The ability to work within the sand and place the

miniatures as they like can be very therapeutic for clients. Those that feel as though

they have little or no control over circumstances in their lives feel a sense of

empowerment through being able to place the miniatures in a way that fits best to

represent themselves.

3. Catharsis in Sandtray: Allows for the expression and awareness of emotions that may

not otherwise be expressed.

4. Inclusiveness in Sandtray: Creates a medium of interaction that a wide range of

individuals, from children to adults can engage in.

5. Metaphor in Sandtray: As clients themselves will create the metaphor in the sand, it

provides a therapeutic metaphor that clients understand and find meaningful within

their own lives.

6. Ability to Foster Deep Self-Disclosure: The visual and kinesthetic properties of the

sand tray allow for a unique sense of trust and safety that may allow for a deeper

sense of self-disclosure.

(Armstrong, 2008).

Each of these strengths identified by Armstrong align with the eleven benefits of sandplay that

Labovitz and Goodwin propose which include:

1. Facilitates of the individuation process.

2. Frees creativity, inner feelings, perceptions and memories, bringing them into outer

reality and providing concrete testimony.

3. Utilizes most of the senses, providing an expanded experience.

4. Regresses the client to past experiences, allowing healing and integration.

5. Creates bridges from the unconscious to the conscious, the inner to the outer world,

mental and spiritual to physical, nonverbal to verbal, thus revealing hidden material.

6. Invites spontaneous play; no right or wrong way.

7. Allows defenses to diminish because it is nonthreatening.

8. Functions as a natural language for children and a common language for use with

diverse cultures and developmental stages.

9. Empowers the client by allowing movement from the position of victim to creator and by

impacting his/her own course of therapy.

10. Serves as an adjunct to therapy, making sandplay available for use by therapists of

various orientations.

11. Provides therapists the opportunity to do personal work.

(Labovitz & Goodwin, 2000, p. 17).

These above strengths within the process align with eleven points that Carey identifies as

capturing the rationale behind the sandtray intervention that include:

1. Allowing for expression of non-verbalized emotional issues. The client does not need

to have any particular creative or artistic ability as the medium provides an

experience free from evaluation.

2. Contains unique kinesthetic qualities. It provides a sensory experience that includes a

kinesthetic e and tactile experience of touching and manipulating the sand. This type

of experience has the potential to be therapeutic in itself.

3. Creates a necessary therapeutic distance for clients. It can be easier to “speak”

through the expression of the miniature rather than through direct verbalization. By

allowing the client to direct the process, this helps to create the necessary distance.

4. It is an inclusive experience. It creates a level playing field for all clients involved,

which can be particularly important in families and group settings.

5. Provides natural boundaries and limits that promote safety for clients. The inherent

limits of the physical sand tray process assist in creating focus for the client.

6. Provides a unique setting for the emergence of metaphors. As these metaphors are

created and directed by the client it allows for a deeper understanding of the

metaphor.

7. Is effective in overcoming client resistance. Given its natural medium for play and the

ability captivate a large diverse audience of clients, it assists in strengthening the

therapeutic relationship and therefore allow for the reduction of client resistance.

8. Provides an alternative effective communication system for clients with poor verbal

skills.

9. Sandtray therapy cuts through verbalization used as a defense. The nonverbal and

expressive nature of sandtray therapy identifies this dynamic and provides a

nonverbal means to address it.

10. Provides a place for the client to experience control. The loss of emotional,

psychological, and physiological control is one of the most distressing by-products of

crisis and conflict. The sandtray process provides control through creative expression.

11. The challenge of transference may be effectively addressed through sandtray therapy.

It has been proposed that the presence of an expressive medium creates and

alternative object of transference and therefore transference occurs between the

client and the tray, rather than between client and therapist.

(Carey, 1999).

4.3: Unique Healing Potential of Group Sandtrays As an emerging technique, group sandtray therapy requires careful explanation of the sandtray

process for each group such as that is able to utilize both parallel and joint play in a therapeutic

environment that encourages safety, a sense of belonging, and exploration of self in relationship

to others (Homeyer & Sweeney, 2011). Through this process, it has the potential to promotes

learning, self-regulation of affect, expression of affection and relatedness, and gradual

development of adaptive behavior to social and collective life, contribute to the synchronous or

complementary imagery in a group, and create collective support and healing (Reece & Ford,

2006; Steinhardt, 2004).

Despite the fact that group sandtray therapy is widely used, research about its efficacy and

underlying dynamic process is widely unavailable (Homeyer & Sweeney, 2011, p.85; Green &

Connolly, 2009; Shen & Chi, 2009; Draper & Ritter, 2003; Ramos & Melo da Mata, 2008;

Steinhardt, 2007; Taki-Reece & Ford, 2007; Morena). One exception is Hughs’ case study (2004)

exploring the understanding of the group dynamics and process through use of sandtrays as one

element in the therapeutic process. The study included a convenience sample of three men and

eleven women, all of whom were professors or graduate students. The qualitative research

included triangulated data from: verbalizations of the participants during the process; interviews

with the participants following the process; and the researcher’s own personal reflections.

Findings suggested that the group process adds an increased richness and healing element to

the sandtray process through promoting a shared trust among the group. This assists in

additional healing as shared meanings emerge to assist the group in detailing verbalizations of

the unconscious during the interpretations process of the sandtray (Hughes, 2004).

5: Case Examples of Sandtray in Oncology and Chronic Illness. To explore the use of sandtrays as a therapeutic modality this section will discuss three case

examples that include: use with chronic illness (Section 5.1); use with breast and ovarian cancer

(Section 5.2); and use with the residential retreat experience for oncology patients (Section 5.3).

5.1: Use with Chronic Illness Many chronic illnesses have the potential for an element of trauma associated with the

experience. This trauma can “impact people of any age at a basic level and sensory level, which

does not lend itself to sophistication, categorization or reason….to require a person of any age

to verbalize when in an emotional crisis may not be fair, and may in fact be-traumatizing”

(Homeyer & Sweeney, p.1). Therefore, to have the opportunity to express this experience

differently for those experiencing chronic illness provides a way of expressing the experience

without having to verbalize it.

Given this potential trauma within illness, Lagutina and colleagues suggest that the internal

representation those with life-threatening illnesses can often be difficult to express through

traditional psychotherapy that involves verbalization. Therefore, they conducted a grounded

theory study of how individuals with a wide range of life-threatening illnesses address the

psychological aspects through sandplay. The study involved interviews with nine sandplay

therapists who presented 23 cases and case vignettes from clients experiencing life-threatening

illnesses. Their findings indicated that symbolic representation through sandplay may assists in

facilitating access to feelings and experiences of illness that may be difficult to address through

verbal therapy alone. The sandplay process can therefore assist in facilitating a process of

integration of the experiencing leading to healing, a process they termed as recovery (Lagutina,

Sperlinger, & Esterhuyzen, 2011). Recovery was conceptualized as the regaining of the ability to

lead a meaningful life, regardless of if the restoration of health is possible. Lagutina and

collegues found that the sandtray experience was able to assist with this by helping patients to

express their lived experiences in the following areas:

1. Significant features of the patient’s histories: Past traumatic events; impact of past

traumatic events; physical problems and treatments; reaction to physical

problems/suffering; initial attitudes towards medical treatments; co-morbid

psychological concerns.

2. Symbolic reflections of inner world experiences: body/symptoms; illness-related

suffering; dissociation; relationship to illness; treatments and surgeries; past trauma;

and portrayal of significant relationships.

3. Working towards restoring wholeness & recovery: Addressing sources of psychic

pain; accessing and integrating resources; restoring flow and movement bringing

together and connecting; working with anger, shame, fear; and healing the body and

symptoms.

4. Preparing for death: Symbolism of sensing the end and letting go; renewing life;

symbolism of crossing over to the other side; spiritual healing and purification.

5. Inner changes manifesting in the external world: positive impact of creating

sandtrays; improving or resolution of physical symptoms; greater acceptance of

illness; taking an active stance in relation to treatment; psychological gains and

behavioral changes.

(Lagutina, Sperlinger, & Esterhuyzen, 2011).

5.2: Use with Breast and Ovarian Cancer Evidence within the sandtray literature for use with oncology patients is limited. One of the few

existing research works into this Area has been Sparling’s dissertation that examined the use of

Jungian approach to sandtray therapy for advanced breast and ovarian cancer patients. The

study included ten planned, time-limited, one-hour therapy sessions followed by a two-hour

review with five breast cancer patients and one ovarian cancer patient. The one hour sessions

utilized Jungian dream work, guided imagery, and sandtray experiences. The study concluded

that sandtray therapy is a useful intervention in a planned, time-limited format and can be

considered a useful complementary therapy treatment for advanced breast and ovarian cancer

patients. The study suggests that sandtray therapy is a useful therapeutic modality for oncology

patients as it is able to:

1. Promote self-reliance by solidifying the patient’s commitment to their own healing

process.

2. Assist in helping the patient confront their guilt and possible depression related to

their illness.

3. Promote acceptance of illness through conscious integration of unconscious material.

4. Facilitate the healing process by being able to integrate spiritual dimensions through

the unconscious process in the sandtray experience.

5. Providing an opportunity for healing into death, or healing into life, as appropriate

based on the oncology patient’s prognosis.

(Sparling, 2002).

The study suggests that the success of the sandtray therapy may be based on the fact that

diagnosis of a life threating illness such as cancer provides an added compulsion/incentive to

work through unconscious feelings. Therefore, those searching for meaning with in a life-

threatening diagnosis may be more open to techniques such as the sandtray experience. Given

the findings from Sparling’s study, further research in this area may be useful (Sparling, 2002).

5.3: Sandtray Execution in Retreat Experience for Oncology Patients This will include a discussion on: sandtray within the context of the retreat experience (Section

5.3.1); setting up the sandtray (Section 5.3.2); introducing the sandtray (Section 5.3.3);

witnessing the creation of scenes in the sand and client interpretation of the sandtray (Section

5.3.4) ; discussion/sharing of the sandtrays (Section 5.3.5); and photographing and recording the

sandtray process (Section 5.3.6).

5.3.1: Sand Tray in the Context of Retreat Experience

The Tapestry residential retreat is a five day retreat program for patients living with any type of

cancer. The retreat takes place at a retreat center in a picturesque, isolated, rural setting and

includes a maximum of 10 participants. As described by Dr. J. Steven Simpson, the retreat

program

“…aims at dealing with psychosocial issues in cancer patients, with a focus on existential

and spiritual domains. The program operates on the philosophy that people are more

than just biological entities. They live in a context, and are bio-psycho-social-spiritual

beings. The program objective is to provide whole-person care. The program

incorporates aspect from physical, mental, and emotional realms, and provides a

journey to help people heal in a holistic sense….it is a unique experience where people

are given a period of respite from their day-to-day responsibilities, and taken care of in

terms of the basic requirements of activities of daily living (shelter, food preparation,

sustenance and clean up). This affords them the opportunity to reflect and focus on

their own healing. The program’s numerous components and activities all act as

potential vehicles for people to do that reflection and integrate the cancer experience

into their life story.” (Dr. J. Steven Simpson, Personal Communication, 2011).

As Angen and colleagues describe, the retreat experience consists of five major components:

1. The creation of a safe ambiance conducive to reflection, relaxation, and respite.

2. Daily narrative group facilitated by professional staff.

3. Use of an arts-in-medicine therapy modality of the story’d basket.

4. Morning and evening sessions of yoga and meditation.

5. Pyscho-educational elements to address complementary therapies, pain control, death,

and dying.

(Angen et al, 2002).

A summary of the activities within the five days of the program can be found in Figure 1. The

sandtray exercise takes place on the morning of the 4th day of the retreat through replacing the

morning daily narrative group.

Time Monday Tuesday Wednesday Thursday Friday

7:00

Yoga / Meditation Yoga / Meditation Yoga / Meditation Yoga / Meditation 7:30

8:00

8:30 Breakfast Breakfast Breakfast Breakfast

9:00 Arrival (after breakfast)

Registration Settling in…

Group Group Sand Tray Group 9:30

10:00

10:30 Free Time Free Time Free Time Free Time

11:00

Art Art Art Closing Meeting 11:30 Orientation Presentation 12:00

12:30 Lunch Lunch Lunch Lunch Lunch

1:00

1:30

Narrative Group Massage and

Relaxation

Free Time

Art

Free Time

Art

Free Time

Art

Depart for Home by 4pm

2:00

2:30

3:00

Free Time & Exploring

3:30

4:00

4:30

5:00 Supper Supper Supper

5:30 Supper

6:00

Video

Free Time Item Exchange 6:30

Video 7:00

Drumming Circle 7:30 Free Time

8:00 Yoga / Meditation Yoga / Meditation

8:30 Yoga / Meditation

9:00

Yoga / Meditation

9:30

10:00

Figure 1: Tapestry retreat schedule with placement of sandtray exercise on the morning of the fourth day of the retreat. (J. Steven Simpson, Personal Communication, 2011).

5.3.2: Setting up the Sandtray room

Within the residential retreat experience the sandtray materials require a dedicated room

within the retreat center. The room consists of large sandtrays broken into pie shaped sections

for each retreat participant to have their own individual space within the sand as demonstrated

in Figure 2. As the literature highlights, it is important to consider the size of the sandtray during

setup. Considerations should include enough space to ensure engagement in the creative

process, but too large of a sandtray has the potential for the client to lose focus on their tray by

becoming overwhelmed with possibilities (Armstrong, 2008; DeDomenico, 1995; Mandelbaum,

2008). In addition, the height and spacing the sand tray should be considered. Chairs/stools

should be available at the appropriate height for the sand table and the therapist should join at

the same level as the client. A final consideration for the preparation of the sand tables is the

distance between the clients and therapists. This distance should be considered such that the

client does not feel invaded or abandoned during their creative process (Armstrong, 2008;

DeDomenico, 1995; Labovitz & Goodwin, 2000; Manxoni, 2011; Remen, 1995).

Figure 2: Sample preparation of sandtray tables within the retreat experience. Of equal importance to the setup of the sand table is the set up for the icons. Within the retreat

setting approximately 850 icons are displayed around the edges of the room and are arranged

by categories as outlined in Figures 3 and 4. As the literature highlights, it is important that they

are displayed in a logical and organized fashion as they may have the potential to be too

distracting if arranged in a disorganized manner. (Armstrong, 2008; DeDomenico, 1995;

Mandelbaum, 2008).

Figure 3: Miniatures/icons used with the retreat experience. The literature also suggests that it is important to provide a relatively large variety of icons as a

limited collection of miniatures can lead to constricting the client’s vocabulary. On the other

hand, too large of a collection can lead to disorganization and may be emotionally flooding for

clients. Providing choices of miniatures within the process is important, particularly for

oncology patients that may experience limited choices within the biomedical portion of their

cancer journey. As described by Lerner,

“Cancer patients often experience themselves as losing all control of their lives. They

become passive objectives of all kinds of decisions and treatments by their medical

teams. They feel they must do what their physicians tell them. They may feel they can

do nothing to help themselves. Often no one has offered them the opportunity to

consider the distinction between healing and curing.” (Lerner, 1996, p. 14).

Therefore, the choices of activities with the retreat experience, as well as an appropriate variety

of choices within the sandtray experience is important for the success of this therapeutic

modality. Choices assist in providing participants with the permission and freedom to explore,

play, create, and imagine (Remen, 1995). The literature suggests that miniatures should be

representative of the client’s world and should include categories such as:

1. People: Family group, brides and grooms, occupational, hobbies, sports, recreation,

stage-of-life figures, historical figures (past and present), fighting and warriors, and

diverse cultures.

2. Animals: prehistoric, zoo/wild, farm/domestic, birds, insects, and sea life.

3. Buildings: houses, business/civil, religious, and historical items.

4. Transportation: cars, trucks, flight vehicles, nautical, and additional transportation

items.

5. Vegetation: trees, bushes, hedges, flowers, and other vegetation items.

6. Fences/Gates/Signs: fences, gates, barricades, and signs.

7. Natural items: sea shells, vegetation, rocks, and minerals

8. Fantasy: magical, magical animals, mythical characters, monsters, folklore, cartoon

and comic book figures, and movie characters.

9. Spiritual/Mystical: western and eastern religions, minority religious groups, and

mystical.

10. Landscape: sky, celestial, topographical, and monuments.

11. Household items: furniture, tools, kitchen items, and other common household

items.

12. Medical items: crutches, band-aids, syringes, and additional medical items.

13. Miscellaneous items: drug/alcohol, reflective surfaces, illuminating objects, aromatic

objects, and spatula/brushes for those that do not want to touch the sand with their

hands.

(Homeyer & Sweeney, 2011; Labovitz and Goodwin, 2000).

Figure 4: Sand tray room with sandtray tables, chairs, and selection of miniatures.

5.3.3: Introducing Sandtray

Within the residential retreat experience participants are gathered for the sandtray experience

in a room completely separate from the set up. The process for introducing the experience

includes a series of instructions vital to assisting in creating the sacred space for the rituals

surrounding the sandtray process. These include:

1. Tibetan bells are rung to calm participants and center their awareness to the present.

2. Reading of the “The Invitation” written by Oriah Mountain Dreamer (see Appendix A)

3. The initial process of the sandtray experience is then explained to participants. One

emphasis is that to this point retreat activities have focused on the past, but this activity

will provide a focus into the future. Participants are asked to walk to the sandtray room

in silence and choose items that appeal to them. When finished, participants are

instructed to take a seat at the sand table and wait for further instructions.

4. “The Summer Day” written by Mary Oliver (see Appendix A) is then read with the focus

on the last two lines of the poem that ask the participants “Tell me, what is it you will do

with your one wild and precious life?”

5. Tibetan bells are rung again and participants move to the sandtray room in silence and

choose a place at the sand table when finished.

6. When all participants are seated they are asked to explore the sand in front of them and

let it take any form they wish. They are encouraged to view the empty sand tray as full

of possibilities and opportunities, a blank canvas on which to explore.

7. Participants are then instructed to place their chosen icons in the sand to tell their story.

Soft music is provided in the background and facilitators witness the process in silence.

5.3.4: Witnessing the Creation of the Sandtrays and Client Interpretation of the Sandtray

Once all of the participants within the retreat process have placed their icons, each participant is

invited to tell their story depicted in the scene they have just created to the level to which they

feel comfortable. Participants are invited to tell “why they chose their icons, what it means to

them and what it represents in their life” (Dr. J. Steven Simpson, Personal communication,

2011). This discussion process of the sandtray allows for patients to explore the impact their

illness has on their values, beliefs and worldviews. This discussion is important as it provides a

profound opportunity for all those present to witness each other’s story. Further honouring of

other’s stories involves the final stage of the process in which the dividers from the middle of

the table are removed so that participants are able to see how their scene blends in with the

stories of the other participants. Participants are then invited to walk around the tables in

silence. They are invited to stop at each scene and offer a silent blessing, prayer, or thought for

the creator of each scene. This process tends to leave most participants “astounded to find that

deep in them there is an intelligence or a wisdom which is unconscious and which can be

invoked and evoked and can speak. To see this happen not only for [themselves], but for all

other [participants] as well as to come to trust the human process even more deeply” (Remen,

1995, p.48).

The effectiveness of this stage of the sandtray experience relies on the client’s experience with

relationships on many levels that may include: relationship between sandplay therapist and

client, relationship with oneself, and relationship with sandplay objects (Costello, 2008). Nearly

three-quarters of the literature surveyed that suggested it is vitally important to the process to

allow clients to describe their own interpretation of their sandtray. This literature suggests that

the sandtray therapist should act as a facilitator, rather than direct, the therapeutic experience

for clients (Ammann, 1994; Homeyer & Sweeney, 2011; Carey, 1999; Bedford-Strohm, 2008; De

Domenic, 2005; Bradway, 1985; Zhou, 1999). As Sparling suggests:

“Only the maker of the images truly experiences the full meaning of her revelation, and

this comes through in the process of physically making the scene, and appreciating it

afterward, and not from interpretation of the images.” (Sparling, 2002, p. 16).

This is particularly important for clients experiencing life threatening illness as they often enter

into the process already disempowered and out of control. As the sandtray therapist facilitates,

rather than choreographs the process, clients will experience healing through a growing sense of

self-control, empowerment, and safety…this facilitation creates the opportunity for the client to

fully express and explore the self (Homeyer & Sweeney, 2011). This work then allows for the

therapist to tailor the healing journey to fit the client, rather than a particular model of

psychotherapy or his/her own agenda. As described by DeDomenico:

“No observer can judge the right or wrong way of expressing their images as they belong to

the imaginable realm of the player who experiences them according to their nature and

according to his/her own sense of correctness. The images simply are what they are to the

person who owns them.” (DeDomenico, 1995, p. V.4).

Just as a large majority of the evidence supports the client interpretation of their sandtray, it

also supports the importance of rituals surround the creation of the sandtray and the

importance of the therapist bearing witness to the process. As best described by DeDomenico:

“Witnessing and observing the entire sand tray play process is absolutely essential. Only

then can anyone appreciate the richness of each and every world created by the player. …no

words, no interpretation and analyses may substitute for nor precede an in-depth, primarily

non-verbal, observational experience…the observer-witness teaches the client to tolerate

and actively experience the expression, manifestation, and experiencing of

psychophysiological experiences….[this relationship] teaches the builder that the activity of

the moment has intrinsic meaning, it more sacred than mundane and more meaningful than

meaningless. Thus, the therapist-observer helps bond the builder to his/her creation”

(DeDomenico, 1995, V.42-43).

The therapist act of bearing witness at this level is multifaceted during the entire process from

entering the room, choosing and discarding miniatures, and in the creation and placement of

the sand tray. This can bring about many emotions in the client such as suspicion, fear, self-

consciousness, freedom, surprise, delight, and many more (Amatruda, 1997; Carey, 1999;

Camerson, 2003; Chiaia, 2006; Hiaia, 2001; DeDomenico, 1995; Labovitz and Goodwin, 2000;

Paolo, 1978; Signell, 1996; Macnofsky, 1996; Weinrib, 1983). Bradway suggests that as the

sandtray experience is meant for healing, it is important that the role of the therapist is to not to

educate, direct, or even to guide. Rather it is to provide freedom, space, protection and

empathy. It allows for validation without words through focusing attention to convey that what

the client is doing as significance, importance, meaning and value (Remen, 1995). It is important

that the therapist provides a free and protected space where the client feels accepted and their

boundaries are accepted. It is not the consciousness of the therapist that leads the process, but

the unconscious of the patient. Therefore, it is important to note that it is not the intellectual

understanding of the therapist that is key in the sandtray process, but rather their empathy,

ability to validate the patient’s experience during the process, and to witness the emergence of

insights that may be previously alien to the patient’s conscious mind (Bradway, 1994; Labovitz &

Goodwin, 2000). Given this important role for the client to be able to interpret their own

sandtray it is important that the client is able to have the cognitive capacity to articulate their

own interpretation of their sandtray (Labovitz & Goodwin, 2000).

Given the multifaceted and essential role of the therapist to create a ritual around witnessing

the sandtray process, DeDomenico suggests that this process of this group sandtray requires

the observer to bear witness through nine different levels of perception that include:

1. Visual Mode: through what is visual witnessed during the process such as choosing

miniatures and placing them

2. Multisensory Mode: Utilizes all senses to become in tune with what is happening

during the process for the client.

3. Physiological-Metabolic Mode: Physiological body sensations that are triggered during

the observational process. Changes in metabolism, breathing, and the nature of these

transient or persistent sensations.

4. Emotional Mode: Feelings which emerge that assist in creating a psychologically,

physiologically, and spiritually unified field of energy in the workspace.

5. Imagining Mode: Internally held images that arise through the witnessing process that

assist in creating a sense of harmony, synthesis, and completion.

6. Secondary (Psychosocial) Thinking Mode: Awareness of thoughts and secondary

process constructs where prejudices, judgments, and values may surface and be

reflected in interactions with the client.

7. Numinous-Spiritual Mode: Rise of deeply numinous or spiritual states evoked during

the observation process that may bring about awareness within a higher self that

provides connection between the client-therapist.

8. Reflective-Integrative Mode: Awareness of own personal associations and memory

patterns that may have linkages and connections to prior experiences.

9. Factual Mode: A journalistic observation and recording of appearances, behaviors and

reactions to the process

(DeDeomenico, 1995).

Labovitz and Goodwin propose that regardless of these nine levels of observation, that the role

of the sandplay therapist includes the following six items:

1. Psychological Container: Holding for the client what is happening in the sand tray and in

the room.

2. Model: Modeling attentive listening, non-judgmental behaviour, and being totally

present.

3. Bond/Link: Linking the unconscious content with the conscious.

4. Helper/Supporter: Supporting the emotions that are evoked and helping the client to

experience those feelings.

5. Co-Explorer: Exploring with the client the meaning of the creation to the client.

6. Witness/Mirror: Witnessing and reflecting back the client’s process, validating and

strengthening the experience.

(Labovitz & Goodwin, 2000, p. 18).

5.3.6: Photographing and Recording the Sand Tray Experience

The final step within the sandtray process involves providing the participants with the option to

photograph their own scene within the tray. Over half of the evidence surveyed spoke to the

power within photographing the sandtray process for the client to capture the scenes that they

have created. As DeDeomenico describes, the sandtray process involves:

“…kinesthetic multi-dimensionality in time and space and is inevitably augmented by

verbal and bodily communications, sand tray play opens a whole new dimension to the

therapeutic process…the world built in the sand tray stands as an actual physical

creation which can be touched, viewed, pondered, discussed, emotionally experienced,

and photographed….it often becomes a joint expression of the intellect, the soul, the

heart, and the body of a human being. It often offers a complete statement of the total

beingness of the [client].” (DeDomenico, 1995, p.4).

Therefore, photographing the sand tray allows for an additional process of witnessing the

sandtray and honouring the unconsciousness. It allows the client to capture that moment in

time to express their growth and keep track of their journey (Amatruda, 1997; Homeyer &

Sweeney, 2011; Labovitz & Goodwin, 2000; Markos, Coker & Jones, 2008; Ammann, 2010; Von

Gantard, 2010; Marcella, 2009). These photographs may be useful for those that engage in the

sandtray process more than once to compare their healing journey over time (Carmichael,

Echols, & Warren, 1997; Synder, 1997; Costello, 2008; Zappacosta, 2009).

6: Connection of Sand Tray Experience to Retreat Program, General Psychosocial Oncology, and Clinical Social Work Practice The elements for the use of sandtrays contains many parallel elements. Table 6.1 highlights

these parallels, along with those related to general psychosocial oncology and clinical social

work practice.

Table 6.1: Parallels between characteristic elements of sandtray therapy, residential retreat programs, general psychosocial oncology, and clinical social work practice.

Program

Element/

Characteristic

Characteristic of

Sandtray Therapy

Connection to

Retreat Program

Connection to General

Psychosocial Oncology

Connection to

Clinical Social Work

Practice

Setting Creating scared space for sandtray: Ensuring that the sandtray activity is created in a safe and protected space

Residential Retreat Setting: allows for respite from day-to-day activities to focus on the spiritual, existential, and holistic experiences of the cancer journey.

Variety of Unique Settings: Has potential to meeting client while they are inpatient, in traditional counselling offices, in cancer clinics, in home, or in hospice care depending on the needs of the client.

Creating comfortable setting for client: Commitment to meeting with the client in a space that is safe, comfortable, and reduces barriers for the client.

Choice/Alternatives Selection of Icons: Provide an appropriate number and selection of icons such that the client is able to have enough choice to symbolize their experience, but is not overwhelmed with choice.

Multimodal Program: A wide variety of activities that stimulate physical, emotional, and creative aspects are made available for patients to choose what fits best for them.

Choice of Counselling Interventions Available: Clients can choose individual, couple, or family therapy depending on many factors related to diagnosis. They may also choose from individual or group interventions.

Ensuring Client Right to Self-Determination: Commitment to empowerment in the therapeutic process through honour the client’s choices.

Group Elements Group Sandtray: Provides an added element to the safety and security of the sandtray experience that allows additional witnessing to their narrative as they explain the scene they created in the sand.

Creation of Community: Community is created through day-to-day activities such as eating meals around a table together, as well as through a balance between group and individual activities.

Creation of Community within groups: Group interventions may be based on type of tumour or stage of disease and patients are encouraged to interact with each other outside of group to form a sense of community for additional supports.

Creation of Community: Common groups may be formed to provide additional support through collation building or for consciousness raising to assist in seeking social justice relating to the lived experiences for individuals.

Narrative/ Storytelling

Client Interpretation of Sandtray: Allows for additional healing for the witnessing of the scene and narrative/explanation of the experience of their sandtray.

Storytelling: Daily narrative group allows the opportunity for patients to tell their stories while having others receive them with kindness.

Therapeutic Content and Process: Provides a space for clients to integrate their cancer journey story into the therapeutic process to assist in the search for meaning.

Acknowledging Inherent Worth of Individuals in the Therapeutic Content and Process: Providing the space for honouring each individuals unique story within the therapeutic process and assisting them in meaning making process.

Rituals Ritual of Sandtray Process: Creates additional level of safe and protected space through ritual of the poems to introduce the activity, silence while choosing the icons and creating the scene, and allowing others to bear witness while explaining the scene.

Rituals of Retreat Program: Rituals are introduced throughout the retreat to create a sense of community and integrate the various activities and create a sense of community.

Rituals with Cancer Care: The biomedical model may not spend as much attention to the psychosocial side of an oncology diagnosis, so counselling provides a ritual place to address additional sources of distress related to the diagnosis.

Rituals within the Therapeutic Process: Provides an opportunity within the therapeutic process to develop and maintain rituals specific to the individual and specific aspects of their journey such as losses, transitions, and additional milestones.

7: Concluding Remarks A review of the literature suggests that while sandtray therapy has been widely in a variety of

settings and regardless of associated philosophical theory guiding the process it has proven to

be beneficial as the sand “links mind and spirit with body to influence each other consciously

and unconsciously. While creating the world, the builder continuously converts mind into

matter” (Labovitz and Goodwin, 2000, p. 18).

While it is clear that there is many areas for further research for the use of sandtrays within the

residential retreat experience for oncology patients, this type of therapeutic modality has been

proven to contain a unique collective human wisdom. As described by Remen :

“I think the group tray is a lot more powerful than an individual tray….patterns emerge

in the sandtray which help people recognize that their pain, their suffering may not be

random, chaotic, and meaningless. Meaning emerges…the thing that always intrigued

me is that some people who appear quite fragile, perhaps they’re very advanced in their

disease or what have you, will do a tray of great power and strength. It’s very interesting

for other people to see that.” (Remen, 1995, p.49).

The literature also clearly identifies that the sandtray as a therapeutic modality is an equally

moving and unique experience for those able to witness the process. As best summarized by

Amatruda:

“Witnessing the sandplay process is a deeply moving, sacred experience. It is a privilege

and a gift to walk through the recesses of the psyche’s garden with our clients. Sandplay

synthesizes the spontaneity of play therapy, the permissiveness and acceptance of inner

child work, the creativity of art therapy, and the enactment of drama therapy. It brings

unconscious material to consciousness, and honors healing of Self and soul…the heart of

sandplay cannot be learned, it can only be felt.” (Amatruda, 1997, p. 4).

Therefore, given this profound potential for healing that allows for the examining the

unconsciousness of the human experience, the process of sandtray therapy is a promising

therapeutic modality within the residential retreat experience for oncology patients with the

potential for much future research in this area.

References

Amatruda, K. (1997). The world where worlds meet. The Journal of Sandplay Therapy. 6(2), 18-23.

Amatruda, K., Simpson, P.H. (1997). Sandplay, The Sacred Healing: A Guide to Symbolic Process. Taos, Trance-Sand-Dance Press:Novato, CA.

Amitay, G., Lahac, R., Roen, P. (2009). Psychiatric assessment of children with poor verbal capacities using a sandplay technique. Primary Psychiatry. 16(12), 38-44.

Ammann, R. (2010). The inner beauty of Hakonia: the inner beauty of sandplay therapy. The Journal of Sandplay therapy. 19(2), 17-23.

Ammann, R. (1994). The sandtray as a garden of the soul. The Journal of Sandtray therapy, IV(1), 46-65.

Armstrong, S. A. (2008). Sandtray therapy: A humanistic approach. Dallas, TX: Ludic Press.

Angen, M., MacRae, J., Simpson, S., Hundleby, M. (2002). Tapestry: A Retreat Experience for Persons Living with Cancer. Cancer Practice. 10(6): 297-304.

Bedford-Strohm, D.(2008). Preparation for Death in Sandplay Therapy: A Journey into light. The Journal of Sandplay Therapy. 17(1).

Bradway, K. (1985). Sandplay Bridges and the Transcendent Function, San Francisco: C. G. Jung Institute.

Bradway, K. and McCoonad, B. (1997). Sand play: Silent Workshop of the Psyche. Florence, KY.

Bradway, K. (1994). Sandplay is meant for healing. The journal of sandplay therapy. 3(2),9-14.

Carey, L. (1999). Sandplay Therapy With Children and Families Published by Jason Aronson, New Jersey. Cameron, S. (2003). Recognizing the appearance of the self in sandplay therapy. The Journal of Sandplay Therapy. 12(1), 13-17.

Canadian Association of Sandplay Therapist. (2011). Sand Tray Therapy: Healing Aspects. Canadian Association for Sandplay Therapists. Available at: http://www.sandplaycanada.ca/home/index.php?option=com_content&view=article&id=53&Itemid=79&lang=en. Accessed on November 4, 2011.

Carmichale, K., Echols, K., Warren, G. (1997). Using sandplay in couples counselling. The Family Journal, 5, 32-36.

Castellana, F. and Kirsch, J. (2006). Analysis and Sandplay: Toward Spanning the Gap. The Journal of Sandplay Therapy, 15(1), 125-129.

Chiaia, M. (2006). History for Sandplay and Analytic Work. The Journal of Sandplay Therapy. 15(2), 11-124.

Costella, C. (2008) Sandplay within the context of relationship. The Journal of Sandplay therapy 17(2), 13-21.

De Domenico, G. (1995). Sand Tray World Play, A Comprehensive Guide to the Use of Sand Tray in Psychotherapeutic Transformational Settings. Vision Quest Images: Oakland, CA.

De Domenico, G. (2005). A Comprehensive Guide to the Use of Sand Tray in Psychotherapeutic Transformational Settings. Vision Quest Images: Oakland, CA.

Draper, K., Ritter, K., Willinghan, E. (2003). Sand Tray Group Counselling with Adolescents. The Journal for Specialists in Group Work. 28(3), 224-260.

Green, E., Connolly, M. (2009). Jugian family sandplay with bereaved children: Implications for play therapists. International Journal of Play Therapy, 18(2), 84-98.

Hiaia, M. (2001). Meeting and creative emergence: the silent interpreting mix of therapist and patient. The Journal of sandplay therapy. 10(2), 7-15.

Homeyer, L. & Sweeney, D. (2011). Sandtray Therapy: A practical Manual. Taylor & Francis Group. NewYork, NY.

Hughes, S. (2004). The group sand tray: A case study. Doctoral dissertation, Union Institute & University.

Kalff, M. (2007). Twenty-One points to be considered in the interpretation of sandplay. The Journal of Sandplay Therapy. 17(1), 51-73.

Kalff,M. (2011). Procedure manual for Research Using Sandplay. Sandplay therapists of America. Available at: http://www.sandplay.org/pdf/Procedure_Manual_Research_Using_Sandplay_Therapy.pdf. Accessed on November 4, 2011.

Kwasniewki, E. (2005).What is Sandtray therapy? Tone Magazine. 20(10),70-72. Available at: http://www.ottawatherapist.ca/articles/Sandtray%20Therapy.pdf. Accessed on November 4, 2011.

Labovitz, B., Goodwin, A. (2000). Sandplay Therapy: A Step-By-Step Manual for Psychotherapists of Various Orientations , Norton Press, New York, NY.

Lagutina, L., Sperlinger, D., Esterhuyzen, A. (2011). Addressing psychological aspects of physical problems through sandplay: A grounded theory study of therapists’ views. Psychology and Psychotherapy: Theory, Research, and Practice. 55, 1-20.

Lerner, M. (1996). Choices in healing and integrating the best of conventional and complementary approaches to cancer. The MIT press. Cambrige: MA.

Lowenfeld,M., (2011). Lowenfeld’s Contribution to the Understanding of Trauma in Sandplay. Transpersonal Sandplay Therapy Center. Available at: http://www.sandplay.net/preschool.htm. Accessed on November 4, 2011.

Macnofsky, S. (1996). Healing into Death. The Journal of Sandplay Therapy. 5(2).

Mattson, D., Veldorale-Brogan, A. (2010). Objectifying the sandtray: An initial example of threedimensional art image analysis for assessment. The Arts in Psychotherapy. 37, 90-96.

Marcella, M. (2009). Time and photography. Visual narratives of a therapeutic relationship. The Journal of Sandplay Therapy. 18(1), 31-35.

Markos, P., Coker, K., Jones, P. (2008). Play in Supervision. Journal of Creativity in Mental Health. 2(3), 3-15.

Mandelbaum, D.(2008). The therapeutic container in sandplay therapy. The Journal of Sandplay Therapy. 17(1).

Manxoni, P. (2011). The body and the wound: Analysis with sandplay process. The Journal of Sandplay therapy. 20(1), 35-54.

Meyer, J. (2004). Relationship in Sandplay—Sandplay in Relationship. The Journal of Sandplay Therapy, 13(1), 44-56.

Morena,G.(2008). Moving forward with sandplay research in San Diego, Califonia. The Journal of Sandplay Therapy. 17(2), 22-27.

Paolo, A.. (1978). Ego and Image: Some observations on the theme of ‘sand play’. Journal of Analytical Psychology. 23(4), 332-338.

Ramos, D.& Melo da Matta. (2008).Sandplay: A method for data analysis. The Journal of Sandplay Therapy. 17(2), 93-116.

Rae, R. (1998). Comparison of Sandtray Approaches. The Sandtray Network Journal. 2(3), 13-15.

Remen, R. (1995). Tradecraft of the Commonweal Cancer Help Program: A Series of Interviews and Discussions with Program Staff. Bolinas, California. Pages 36-56.

Rousseau, C., Benoit, M., Lacroix, L., Gauthier. (2009). Evaluation of a sandplay program for preschoolers in a multiethnic neighbourhood. Journal of Child Psychology and Psychiatry. 50(6), 743-750.

SandTray Therapy Insitute. (2011). Sandtray VS Sandplay. How do they compare? SandTray Therapy Institute. Available at: http://www.sandtraytherapyinstitute.com/humanistic-sandtray-therapy/sandtray-vs-sandplay-how-they-compare/. Accessed on November 4, 2011.

Sandtray Network (2011). What We Do. Sandtray Network. Available at: http://www.sandtray.org/what_we_do.html . Accessed on November 4, 2011.

Shen, Y. Chi, T., Armstrong, S. (2008). Impact of group sandtray on self-esteem of young adolescent girls. The Journal for Specialists in Group Work. 33(2), 118-137.

Signell, K. (1996). Silence and Sandplay. The Journal of Sandplay Therapy. 5(2).

Sparling, W. (2002). From healing into life to healing into death: The Sandplay Project. A clinical study utilizing Jungian psychology complement conventional breast or ovarian cancer treatment. PhD Dissertation. Union Institute and University

Steinhardt, L. (2007). Group Sandplay and Visual Reality. The Journal of Sandplay Therapy. 16(2), 13-18.

Steinhardt, L. (2004). Relationship in Large Group Experiential Sandplay Training. The Journal of Sandplay Therapy. 13(2), 29-44.

Synder, B. (1997). Expressive art therapy techniques: Healing the soul through creativity. Journal of Humanisitic Education and Development. 36(2), 74-79.

Taki-Reece, S., and Ford, C. (2007). The Frontiner of Group Sandplay. The Journal of Sandplay Therapy. 16(2), 19-22.

Taki-Reece, S. and Ford, C. (2006). All the children: Can group sandplay help met the growing need? The Journal of Sandplay Therapy. 15(2), 87-110.

Turner, B. (1994). Symbolic process and the role of the therapist in sandplay. The Journal of Sandplay Therapy. 3(2), 84-96.

Von Gantard, A. (2010). Sandplay therapy study: a prospective outcome study of sandplay therapy with children and adolescents. The Journal of Sandplay therapy. 19(2), 34-40.

Weinrib, E. (1983). Images Self: The Sandplay Therapy Process. Sigo Press, Boston, MA.

Zappacosta, J. (2009). Landscape, place and Identity in Sandplay Therapy. The Journal of Sandplay Therapy. 18(1), 7-13.

Zhou, D. (1999). A review of sandplay therapy. International Journal of Psychological Studies, 1(2), 69-72.

Appendix A

The InvitationIt doesn’t interest me what you do for a living.

I want to know what you ache for

and if you dare to dream of meeting your heart’s

longing.

It doesn’t interest me how old you are.

I want to know if you will risk looking like a

fool

for love

for your dream

for the adventure of being alive.

It doesn’t interest me what planets are squaring

your moon…

I want to know if you have touched the centre of

your own sorrow

if you have been opened by life’s betrayals

or have become shriveled and closed

from fear of further pain.

I want to know if you can sit with pain

mine or your own

without moving to hide it

or fade it

or fix it.

I want to know if you can be with joy

mine or your own

if you can dance with wildness

and let the ecstasy fill you to the tips of your

fingers and toes

without cautioning us to

be careful

be realistic

remember the limitations of being human.

It doesn’t interest me if the story you are telling

me

is true.

I want to know if you can

disappoint another

to be true to yourself.

If you can bear the accusation of betrayal

and not betray your own soul.

If you can be faithless

and therefore trustworthy.

I want to know if you can see Beauty

even when it is not pretty

every day.

And if you can source your own life

from its presence

I want to know if you can live with failure

yours and mine

and still stand at the edge of the lake

and shout to the silver of the full moon,

“Yes.”

It doesn’t interest me

to know where you live or how much money you

have.

I want to know if you can get up

after the night of grief and despair

weary and bruised to the bone

and do what needs to be done

to feed the children

It doesn’t interest me who you know

or how you came to be here

I want to know if you will stand

in the centre of the fire

with me

and not shrink back.

It doesn’t interest me where or what or with

whom

you have studied

I want to know what sustains you

from the inside

when all else falls away.

I want to know if you can be alone

with yourself

and if you truly like the company you keep

in the empty moments.

Oriah Mountain Dreamer

SAND TRAY IN RETREAT EXPERIENCE FOR ONCOLOGY PATIENTS

34 | P a g e

The Summer Day

Who made the world?

Who made the swan, and the black bear?

Who made the grasshopper?

This grasshopper, I mean –

the one who has flung herself out of the grass,

the one who is eating sugar out of my hand,

who is moving her jaws back and forth instead of up and down –

who is gazing around with her enormous and complicated eyes.

Now she lifts her pale forearms and thoroughly washes her face.

Now she snaps her wings open, and floats away.

I don’t know exactly what a prayer is.

I do know how to pay attention, how to fall down

into the grass, how to kneel down in the grass,

how to be idle and blessed, how to stroll through the fields,

which is what I have been doing all day.

Tell me, what else should I have done?

Doesn’t everything die at last, and too soon?

Tell me, what is it you plan to do

with your one wild and precious life?

Mary Oliver

New and Selected Poems

Beacon Press